Correspondence

Surgery for Breast Cancer

N Engl J Med 1995; 332:64January 5, 1995

Article

To the Editor:

The recent polemics concerning the study of the National Surgical Adjuvant Breast and Bowel Project (NSABP) have been followed closely by oncologists, including those outside the United States. If anything, the matter proves that quality-assurance procedures are absolutely necessary in multicenter trials.

In your editorial (May 19 issue),1 you say that the conclusions of the trial are unlikely to be altered. “Furthermore,” you note, “a number of other studies, published after the reports from the NSABP, have come to the same conclusions.” This sentence suggests that the NSABP study was the first to demonstrate that lumpectomy and irradiation are as effective as mastectomy in patients with operable breast cancer. This is not the case. Every oncologist familiar with the treatment of breast cancer knows that the European experience is much longer. Two of the randomized studies cited in the editorial were reported before 1985.2,3 It is well known that treatment policies in the United States changed only after publication of the report on the American trial, which makes it, for the United States, the most important trial. It was, however, certainly not the first.

W. Van den Bogaert, M.D., Ph.D.
E. van der Schueren, M.D., Ph.D.
Universitair Ziekenhuis, St. Rafaël, B-3000 Leuven, Belgium

3 References

1. 1

   Angell M, Kassirer JP. Setting the record straight in the breast-cancer trials. N Engl J Med 1994;330:1448-1450
   Full Text | Web of Science | Medline

2. 2

   Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quandrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 1981;305:6-11
   Full Text | Web of Science | Medline

3. 3

   Sarrazin D, Le M, Rouesse J, et al. Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less: the experience of the Institut Gustave-Roussy. Cancer 1984;53:1209-1213
   CrossRef | Web of Science | Medline